FAQs About Plasmapheresis for CAD
Cold agglutinin disease (CAD) is a rare disorder in which the immune system produces autoantibodies that attack the body’s own red blood cells when exposed to cold temperatures. Plasmapheresis can provide temporary relief of symptoms by removing autoantibodies from the blood. Here
Following are a few frequently asked questions about the procedure.
What is plasmapheresis?
Plasmapheresis, also called automated plasma exchange, is a procedure that removes and replaces plasma, which is the liquid part of blood. It contains salts, sugars, fats, vitamins, hormones and antibodies.
Why would I need plasmapheresis?
Most CAD patients are able to manage their symptoms by avoiding cold temperatures. If you have a more severe form of CAD that does not respond to other treatments, or you are having serious complications such as rapid hemolysis (the rapid breakdown of red blood cells) and anemia (low levels of red blood cells), you may need plasmapheresis to reduce the levels of autoantibodies attacking your cells. You also may need plasmapheresis before undergoing a surgery that requires your body temperature to be lowered, such as heart surgery.
How does it work?
During the procedure, medical staff inserts two needles into your veins. Blood comes out of one vein, passes through a machine, and then returns to your body through the other needle. The machine separates the plasma from the blood cells and then adds the blood cells to fresh plasma or a plasma replacement before returning it to your body.
A slightly different method of filtering the autoantibodies also is available. In this method called cryofiltration apheresis, the machine removes your blood as usual and separates the blood cells and plasma. Then the plasma is cooled to cause autoantibodies to clump together, which then can be filtered out before warming the plasma, recombining it with the blood cells, and returning them to the body.
How long does the procedure take?
The procedure usually takes one to three hours depending on your size and the amount of blood that needs filtering.
What are the risks of plasmapheresis?
There are a number of side effects that you might experience from plasmapheresis. The most common include pain, bleeding, and bruising at the needle insertion sites. There also is a risk of infection at the needle sites. It is possible for the procedure to cause low blood pressure and you might feel dizzy, light-headed, or faint.
Clinicians add an anticoagulant to your blood to keep it from clumping together while it is outside of your body. This can make it harder for your body to form blood clots and stop bleeding for a little while after the procedure. The anticoagulant can sometimes join with calcium in your body and lead to reduced calcium levels.
You may have a reaction to the procedure and might have fever or chills, nausea, vomiting, severe pain, trouble breathing, itching or a rash, an irregular heartbeat, or even seizures.
How long does it take to recover?
You usually will be able to go home shortly after the procedure once the medical staff makes sure you are not having any side effects. You probably will feel tired, and you should drink plenty of fluids before and after the procedure. You may wish to have someone drive you home after the procedure and avoid exercising until you recover fully.
Can I undergo plasmapheresis at home?
Plasmapheresis requires expensive equipment and medical supplies that are not easy to transport. In case of serious side effects, it also is important that you be near a medical treatment facility. For these reasons, plasmapheresis usually takes place in hospitals, outpatient clinics or blood banks. However, some physicians’ offices may offer it.
What are the outcomes?
Plasmapheresis is a temporary solution as a response to a sudden severe reaction, or until other treatments such as suppression of the immune system have a chance to take effect. This is because plasmapheresis does not stop the production of more autoantibodies.
No clinical trials have been done to investigate the effectiveness of plasmapheresis in CAD, but case studies have shown that it does reduce the levels of autoantibodies in the bloodstream and provide short-term relief of symptoms.
Last updated: Jan. 28, 2021
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